Varicella vaccine and fatal outcome in leukaemia

Abstract

In their unusual and dramatic Case Report (April 7, p 1232),1Schrauder A Henke-Gendo C Seidemann K et al.Varicella vaccination in a child with acute lymphoblastic leukaemia.Lancet. 2007; 369: 1232Summary Full Text Full Text PDF PubMed Scopus (59) Google Scholar André Schrauder and colleagues describe a 4-year-old girl with acute lymphoblastic leukaemia and varicella who died of multiple-organ failure and other complications. She had received live attenuated varicella zoster virus (VZV) vaccine 1 month before the onset of symptoms. Understandably, Schrauder and colleagues focus on the clinical information and comment to a lesser degree on the laboratory test used to differentiate between wild-type VZV and VZV vaccine strain.This case illustrates the importance of doing this test for many reasons. It has important implications from diagnostic, therapeutic, epidemiological, and infection-control points of view, both in immunocompromised and immunocompetent patients. Specific PCR tests to differentiate wild-type from vaccine-strain VZV are available in a few laboratories around the world.2Campsall PA Au NHC Prendiville JS Speert DP Tang R Thomas EE Detection and genotyping of varicella-zoster virus by Taq-Man allelic discrimination Real-time PCR.J Clin Microbiol. 2004; 42: 1409-1413Crossref PubMed Scopus (51) Google Scholar, 3Parker SP Quinlivan M Taha Y Breuer J Genotyping of varicella-zoster virus and the discrimination of Oka vaccine strains by Taq-Man real time PCR.J Clin Microbiol. 2006; 44: 3911-3914Crossref PubMed Scopus (36) Google Scholar, 4Takayama M Takayama N New method of differentiating wild-type varicella-zoster virus (VZV) strains from Oka varicella vaccine strain by VZV ORF 6-based PCR and restriction fragment length polymorphism analysis.J Clin Virol. 2004; 29: 113-119Summary Full Text Full Text PDF PubMed Scopus (15) Google Scholar, 5Espy MJ Uhl JR Sloan LM et al.Real-time PCR in clinical microbiology: applications for routine laboratory testing.Clin Microbiol Rev. 2006; 19: 165-256Crossref PubMed Scopus (969) Google Scholar With these tests, results can be obtained quickly from specimens obtained from blood, cerebrospinal fluid, vesicles, and some tissues. Besides these benefits, VZV viral load can be measured by TaqMan PCR, which helps in the monitoring of disseminated disease progression and response to antiviral treatment, among other benefits.2Campsall PA Au NHC Prendiville JS Speert DP Tang R Thomas EE Detection and genotyping of varicella-zoster virus by Taq-Man allelic discrimination Real-time PCR.J Clin Microbiol. 2004; 42: 1409-1413Crossref PubMed Scopus (51) Google ScholarAlso, early distinction of the two different VZV scenarios is crucial for the correct management of exposed individuals in hospital and community settings, including neonates, pregnant women, immunosuppressed patients, and high-risk individuals.I declare that I have no conflict of interest. In their unusual and dramatic Case Report (April 7, p 1232),1Schrauder A Henke-Gendo C Seidemann K et al.Varicella vaccination in a child with acute lymphoblastic leukaemia.Lancet. 2007; 369: 1232Summary Full Text Full Text PDF PubMed Scopus (59) Google Scholar André Schrauder and colleagues describe a 4-year-old girl with acute lymphoblastic leukaemia and varicella who died of multiple-organ failure and other complications. She had received live attenuated varicella zoster virus (VZV) vaccine 1 month before the onset of symptoms. Understandably, Schrauder and colleagues focus on the clinical information and comment to a lesser degree on the laboratory test used to differentiate between wild-type VZV and VZV vaccine strain. This case illustrates the importance of doing this test for many reasons. It has important implications from diagnostic, therapeutic, epidemiological, and infection-control points of view, both in immunocompromised and immunocompetent patients. Specific PCR tests to differentiate wild-type from vaccine-strain VZV are available in a few laboratories around the world.2Campsall PA Au NHC Prendiville JS Speert DP Tang R Thomas EE Detection and genotyping of varicella-zoster virus by Taq-Man allelic discrimination Real-time PCR.J Clin Microbiol. 2004; 42: 1409-1413Crossref PubMed Scopus (51) Google Scholar, 3Parker SP Quinlivan M Taha Y Breuer J Genotyping of varicella-zoster virus and the discrimination of Oka vaccine strains by Taq-Man real time PCR.J Clin Microbiol. 2006; 44: 3911-3914Crossref PubMed Scopus (36) Google Scholar, 4Takayama M Takayama N New method of differentiating wild-type varicella-zoster virus (VZV) strains from Oka varicella vaccine strain by VZV ORF 6-based PCR and restriction fragment length polymorphism analysis.J Clin Virol. 2004; 29: 113-119Summary Full Text Full Text PDF PubMed Scopus (15) Google Scholar, 5Espy MJ Uhl JR Sloan LM et al.Real-time PCR in clinical microbiology: applications for routine laboratory testing.Clin Microbiol Rev. 2006; 19: 165-256Crossref PubMed Scopus (969) Google Scholar With these tests, results can be obtained quickly from specimens obtained from blood, cerebrospinal fluid, vesicles, and some tissues. Besides these benefits, VZV viral load can be measured by TaqMan PCR, which helps in the monitoring of disseminated disease progression and response to antiviral treatment, among other benefits.2Campsall PA Au NHC Prendiville JS Speert DP Tang R Thomas EE Detection and genotyping of varicella-zoster virus by Taq-Man allelic discrimination Real-time PCR.J Clin Microbiol. 2004; 42: 1409-1413Crossref PubMed Scopus (51) Google Scholar Also, early distinction of the two different VZV scenarios is crucial for the correct management of exposed individuals in hospital and community settings, including neonates, pregnant women, immunosuppressed patients, and high-risk individuals. I declare that I have no conflict of interest. The deteriorating health situation in IraqThe health situation in Iraq is deteriorating on almost every level. In this week's issue, two doctors from Basrah describe how insulin is unavailable because it is not safe to distribute it. Last month the first cases of cholera were reported. And in an interview with the non-governmental organisation Doctors for Iraq, Khaled Mahmud, head of resident doctors in Samarra General Hospital , described how power outages prevented the use of all the medical appliances in the hospital. Full-Text PDF